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Taking My Private Practice “Paperless”

By Jessica Lang Kosa, PhD, IBCLC

Going Paperless means no more of THIS!

Going Paperless means no more of THIS!

I’m writing this in the YMCA lobby while my daughter is in swim class. As an independent IBCLC working in a solo private practice and the mother of three, I need to use these little chunks of time. This was one of my main goals when I decided to change my practice to a “paperless” one. Being “paperless” means that all of my charting, records, communications, and care plans are recorded on one of my electronic devices. I have an hour while she swims. I have emails from clients with questions. I want to check their records before responding to them, even if it’s just to make sure I know the baby’s name and age. Having a paperless practice gives me access to my records via my phone or ipad.

One of the strongest reasons for making this switch was the need to combine emails with the rest of my client records. Nearly all of my clients do email me at some point, and I wanted to integrate a record of those communications in the client’s chart. Printing out emails and stapling them to the consult report seemed tedious and
wasteful. Making the whole record electronic solved that problem.

Other IBCLCs may consider going paperless for many reasons – avoiding paper waste,
saving storage space, and ease of communication with clients and other providers are
also benefits. I’ve also seen many different ways of approaching a paperless practice.
Here I’ll describe my system, not to suggest this is the correct or best way, but to offer it
up for others to improve on.

The first step is having the clients fill out my online intake form and sign my consent form. For this, I use Formsite – I already had an account because I use it for registration for my breastfeeding classes. It’s web-based, so it can be used by anyone, regardless of what type of computer they have. An alternative would be to have an intake form built into your website but, for many, any changes would require having to pay to have updates made by the person who runs your website. Formsite has a secure server feature, allowing for HIPAA-compliant collection of protected information. These features required a paid account on Formsite, but you can get a basic account for free to try it out.

Building my intake form using their interface was time consuming, but not difficult. It allows you to drag and drop questions of different types (checkbox, multiple choice, text answer, date) as well as arrange and format them. I built my consent form and HIPAA notice in as well. When a client makes an appointment, I give her the link and password to access the form. (If she didn’t have internet, I’d go back to a paper form, but it’s only happened once.) When she fills it out, the site sends me an email notification. I log into Formsite and download the info as a spreadsheet. Then begins the fun.

I paste the spreadsheet including the intake info into an app called Bento. This is a Mac based program – if you have a PC, you would paste it into Excel or whatever spreadsheet
program you like. I chose Bento because it was the only app I found that would combine
emails, spreadsheet data, photos, and files all together. Now, when a client emails to
say the baby is up to 8 lbs., I can drag the email into her record in Bento. If she sends
me a picture, ditto. And her care plan and pediatrician’s report will be in there too.

At the actual consult, I use Bento on an ipad. It syncs with my home computer.
Important note – it syncs over my own home network, not through the cloud. The question of HIPAA compliance and the cloud remains formally unanswered, so I felt it behooves me to keep clinical info out of the cloud. (Yes, unencrypted email is also a potential HIPAA concern, so I address that in my consent form. And I don’t text with clients at all, except about scheduling.)

Bento allows me to create forms on my ipad to visually organize info. I have one form
that shows the intake info she gave me online, one with her doctors’ contact info, one
for the evaluation I do at the consult, one for followup info, and one for my superbill. I
use checkboxes and dropdown menus as much as possible so that I spend minimal
time typing. I complete the evaluation form as I go along, during the consult. At the
end, I complete the superbill, which I will export as a PDF file to send her. The followup
form will contain her care plan and report (as PDF files), emails, notes on phone calls,
or any subsequent visits. The providers’ form is linked to a database of doctors, so I
can easily look up their phone or fax numbers.

Another nice aspect of this – by using checkboxes, I can easily quantify data across my
whole practice, such as what percentage of babies I referred for tongue tie.

I could create Bento forms for my reports and care plans, but I haven’t. Bento doesn’t
allow for a lot of formatting, and I like them to be in letter form, so I do those separately
using Pages (Mac’s word processor.) I save the care plan and report as PDF file. I
email the care plan to the client, along with her superbill and any handouts or additional
info I want to send her, and I use PamFax (there are many other choices for online
faxing) to fax the report to the pediatrician and OB/GYN.

With all-electronic records, backup is critical. I use Carbonite for remote backup (if my house burns down, or my computer is stolen), and Time Machine for easy local backup (if my computer freaks out.) Both of these happen automatically.

All of this takes some investment of time to get up and running, but I’ve definitely found
that it makes my practice run more smoothly.

JLKJessica Lang Kosa is an International Board Certified Lactation Consultant in private practice in the Boston area.  She offers home visits for comprehensive breastfeeding help, and teaches courses in breastfeeding support for professionals who work with mothers and babies.


Establishing a Breastfeeding Clinic in Guadalajara, Mexico

By Barbara Oñate, IBCLC

Before I became an International Board Certified Lactation Consultant (IBCLC), I had the opportunity to visit a friend 24 hours postpartum in the most expensive hospital suite available in my hometown in Mexico. I was truly aghast to see she had such damaged and bleeding nipples. I asked her who was helping her at the hospital and she replied that the nurses told that her she needed to “wipe her nipples and withstand the pain”. You can imagine how desperate I was for my friend so I sat with her and helped as much as possible with what I knew from my own breastfeeding experiences. I went back to the United States amazed by how poorly women were served, even in the most expensive birthing facilities available.  That is when I decided to pursue becoming an IBCLC.

Five years ago, my family and I moved back to Mexico and I was ready to help. There was very little lactation support available in my community and few people were aware of how IBCLCs could impact breastfeeding for mothers and babies.  While studying to meet the requirements for certification,  I worked for free at a local hospital in Guadalajara. The use of formula for infants was “protocol” in my facility and a representative of a formula company regularly did “lactation rounds” in the hospital. I was diligent in my efforts to meet with mothers just after this representative had visited their room and support moms and babies while combating the poor information she had given. I would help the mother and baby latch-on after 10-20 hrs of separation with their babies, fully fed with bottles and formula. Before long, patients began coming to the hospital asking for my help. Not long after, the formula representative simply quit coming and I was left with the whole maternity floor to myself! This is how pediatricians and OB’s started to trust me, call me and even consult with me. I soon began my own private practice.  With the contact hours I was afforded at the hospital and in my practice, I applied for my IBCLC exam and in October 2009, I earn my certification.

As my practice grew, I began noticing that a large number of mothers were wanting to breastfeed but lacked support and the adequate tools. Our country of 120 million people is experiencing a significant lack of IBCLC care (ed. note: IBLCE notes that, as of April 2012, there are 19 IBCLCs in the entire country). I began to contacting those in the community with the power to effect change, asking them how we could provide more support to Mexico’s mothers and babies.  One said to me, “I see your passion about breastfeeding and I can see how important it is for babies and mother’s. I think we have to do something about it”. We recognized together that increasing breastfeeding rates could have a significant impact on Mexico!

We now have a lovely breastfeeding clinic in Guadalajara and we hope to open 14 more throughout Mexico. We are also launching an educational campaign on social media to educate moms and empower them in regards to their breastfeeding “powers” and rights. We are setting up a nationwide breastfeeding call center and we are negotiating with private insurers to provide breastfeeding benefits for all their clients.  We are starting to see wonderful momentum from mothers who are finding the kind of support they deserve. We are devoted to giving to our beautiful country smarter, healthier, and more attached babies, mothers and families.

I think all IBCLCs need to find the power in their passion. We are saving lives every day. We are the soldiers, fighting for infants’ lives and we need to stand tall in every corner of the world. I always tell my trainees, “If we do our jobs right today, we can save families from difficulties or problems they will never know thanks to breastfeeding”.


Clinicians in the Trenches – Leigh Anne O’Connor

Written by: Amber McCann, IBCLC, Owner of Nourish Breastfeeding Support

I had the privilege of meeting Leigh Anne O’Connor at a conference last spring. The enthusiasm and confidence that drew me to her translates into the work she does with mothers and babies in Manhattan. We are honored, at Lactation Matters, to be able to share with you about the work Leigh Anne is doing.

Leigh Ann O’Connor lives in Manhattan, with her husband and their three children. She has spent more than 9 years as an IBCLC lecturing for professional organizations, setting up Corporate Lactation programs, teaching breastfeeding classes, leading support groups and seeing private clients all over New York City. You might have seen her on Bravo’s Pregnant in Heels, The Doctors and TLC’s Bringing Home Baby as an expert and advocate for breastfeeding. She has also been a Guest Lecturer at Columbia University Teachers College.

How did you come to be an IBCLC?

After struggling for a few days with breastfeeding, I fell in love with it. It was amazing watching my daughter, Phoebe, grow so big, happy and healthy – all at my breast.
My sister-in-law encouraged me to attend a La Leche League (LLL) Meeting, where I felt right at home. I became a leader with the organization and since many of the Leaders whom I respected were also IBCLCs, they encouraged me to work toward that goal.

What does a typical week of working with mothers look like for you?

I take my two younger children to school every morning and then I usually head off to see mothers and babies in their homes. If you were with me, you would see me on my phone answering questions and cheerleading a mom. In the park, I have been known to do quick consults and to touch my breasts as I demonstrate how to hand express over the phone. I pepper the time at home with e-mails and phone calls to clients in between dinner and homework with the kids.

In addition to leading LLL Meetings (including a Toddler meeting that I adore), I also have a support group/clinic twice a month. This is a great way for me to follow up with clients and to help mothers. The beauty of it is the mother-to-mother support. They really get into supporting each other and encouraging each other. They talk parenting philosophy. I answer more technical questions, but it is really about them finding their voices and owning their mothering.

What are your biggest challenges of working in Manhattan?

One of the biggest challenges is the weather. When it is nice, Manhattan is a pleasure. Toting around my scale can be tough. When I have my scale and my bag and I have to go to a fifth or sixth floor walk-up apartment, that is challenging. When there is rain or snow, it is hard to carry my supplies and an umbrella. My scale is on a cart with wheels, which I pull along behind me, but in snow it is a real drag. Also, toting my supplies up and down the stairs of the subway or on the bus is tiresome. Sometimes I spring for a taxi, but it really gets costly. I love when a client is nearby and I can walk to her home on a nice sunny day.

Also, we live in a highly competitive atmosphere. Many women are returning to work early or they are trying to create an idyllic life and that just does not mesh with young baby feeding. There is a big environment of sleep training and heavy scheduling. Often, I am helping a mother to learn to trust her instincts, to trust her baby and to not try to fit her round baby into a square hole.

What advice would you offer to other private practice IBCLCs?

I had one intern ask me, “How did you know you really want to be a Lactation Consultant?” I laughed because I live and breathe breastfeeding. I can always turn a cocktail party conversation into a breastfeeding conversation. I relate most of life back to breastfeeding. I think that the start is having a passion for breastfeeding, babies and families. You study hard and volunteer. Put yourself into the breastfeeding world. I like mother-to-mother support meetings because they help me know what is normal. A Private Practice Lactation Consultant often sees only problematic breastfeeding and her ideas about breastfeeding can become skewed, so, being in the company of normal is so important. I think that is why I love my Toddler Meeting so much. Breastfeeding a toddler is normal.

Also, if possible, shadow as many different IBCLC’s as possible. We are all a bit different but we all have something to teach.

I think I learned the most from nursing my three children – two of whom were tongue-tied!  And, I continue to learn from every mother I see.


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